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Organization
THE CELIAC SPACE, LLC
Active
Organization
THE CELIAC SPACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN KENNY RD (OWNER)
(949) 282-9928
Entity
Organization
Contact information
Practice address
60 FOUR T RANCH RD, GEORGETOWN, TX 78633-4350
(949) 282-9928
Mailing address
60 FOUR T RANCH RD, GEORGETOWN, TX 78633-4350
(949) 282-9928
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86096130
ACADEMY OF NUTRITION AND DIETETICS
—
01
—
DT85889
TEXAS LICENSED DIETITIAN
TX
Enumeration date
11/30/2019
Last updated
03/22/2023
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